DESCRIPTION: (Applicant's Description) Dr. Katrina Armstrong, a National Research Service Award Fellow in the Division of General Internal Medicine at the University of Pennsylvania, is applying for a Preventive Oncology Career Development Award to develop and enhance the skills necessary for an academic career as an independent investigator. The candidate's career goal is to develop a multidisciplinary program to (1) study the use and outcomes of genetic cancer susceptibility testing and (2) develop and assess strategies for effectively incorporating genetic cancer susceptibility testing into primary care medicine. The Preventive Oncology Award will provide the means to take two important steps towards implementing this goal. First, it will allow for additional education in epidemiology, cancer genetics, and health behavior that will augment the candidate's previous training in epidemiology, biostatistics and general internal medicine, and lead to a Ph.D. in Epidemiology. Second, it will support an original clinical research program using rigorous epidemiologic methods to examine how risk perception, risk communication and other factors influence the actual utilization of testing for BRCA1/2 mutations. In the last ten years, the identification of cancer susceptibility genes has transformed genetic susceptibility testing for common cancers from a distant promise to an immediate clinical reality. Despite the simple appeal of defining individual risk based on genetic susceptibility, the practical reality of genetic susceptibility testing is complex. For testing to succeed in identifying high risk individuals in an environment where cost and other concerns are likely to preclude population based screening, counseling and testing must be directed to individuals at risk of carrying a mutation. Very little is known about the factors affecting the utilization of genetic testing outside a research setting. Understanding the role of risk perception and risk communication in this process is critical to our ability to direct limited counseling and testing resources to individuals at risk, and, thereby, realize the maximum clinical and public health benefit from genetic susceptibility testing. In this application, the candidate proposes a two-part research plan that is an innovative approach to important, unanswered questions about genetic testing for cancer susceptibility. The first study will use a case-control design to compare women who undergo genetic counseling for breast cancer susceptibility to women from the same population who do not. The second study will use a prospective cohort design to measure the effect of genetic counseling on risk perception and the relationship between risk perception, predicted risk and decisions about genetic susceptibility testing. Together, these studies will provide a comprehensive overview of the utilization of BRCA 1/2 testing and form the foundation for the candidate's transition to an independent researcher in preventive oncology.